What is alopecia?
Alopecia is hair loss or baldness in an area that is usually covered by hair,
such as the scalp. There are various types of alopecia:
- Male-pattern balding, a receding hairline with
moderate to extensive loss at the crown.
- Female-pattern balding, a gradual thinning with
moderate loss at the hairline, but mostly on the crown
- Alopecia areata, a progressive condition characterised
by patchy hair loss in children and young adults. This often begins suddenly.
Hair loss is usually confined to the head and face, although the entire body
may be involved. In about 60% of cases, hair regrows within a few years.
- Alopecia capitalis totalis, hair loss involving the
entire head (alopecia areata of the whole head).
- Alopecia universalis, a condition in which all body
hair falls out and is unlikely to grow again, especially when it occurs in
children (alopecia areata of the whole body).
- Involutional alopecia, the natural condition of
gradually thinning hair as one gets older. More and more hair follicles, from
which the hair grows, go into a resting stage (telogen effluvium) and the
remaining strands
of hair become shorter and fewer in number.
- Trichotillomania is a psychiatric disorder in which
one pulls out one’s own hair. It is most frequently seen in children.
- Telogen effluvium, excessive hair loss evenly distributed over the scalp,
is caused by various illnesses, fever, childbirth, rapid weight loss, thyroid
problems, iron deficiency and certain drugs.
What are the symptoms?
- Men: thinning hair on the scalp, a receding hairline,
or a horseshoe-shaped pattern that leaves the crown of the head exposed.
- Women: thinning of hair in general, but mainly on the
crown; complete balding is rare.
- Children and young adults: sudden loss of patches of
hair (alopecia areata).
- Complete loss of all hair on the body (alopecia
universalis).
- Patches of broken hairs and incomplete hair loss on
the scalp and eyebrows (trichotillomania).
- Excessive shedding of hair, but not complete baldness
(telogen effluvium).
- Gradual thinning of hair with age, where hair becomes sparser and shorter
(involutional alopecia).
What are the causes?
Heredity is the primary cause of 99% of permanent alopecia. Your genes influence
your predisposition to male or female pattern balding.
Although your level of androgens (a male hormone produced by both
men and women) is the main factor, hair loss has nothing to do with virility. In instances
of temporary alopecia or when follicles go into a resting phase, the causes
may be found in factors such as:
- Stress
- Severe illness
- High fever
- Childbirth
- Hormonal imbalance
- Underactive or overactive thyroid gland
- Medication (such as those for high blood pressure,
high cholesterol, arthritis, ulcers, acne, and chemotherapy, as well as
anticoagulants and oral contraceptives)
- Infection of the scalp
- Scalp injuries
- Autoimmune reaction
- Iron deficiency
- General anaesthesia
- Burns
- X-rays
- Exposure to chemicals (such as swimming-pool
chemicals, bleaches, dyes and perm preparations)
- Washing your hair too frequently (uncommon), tight braiding, hot curlers, etc.
Alopecia areata is an autoimmune disease.
Course
Although heredity is
the biggest factor in determining when you will begin to lose your hair
in male-pattern balding, age is almost as important a factor. Men can begin to lose hair
in their teens or twenties. By age 60, most men have some degree of baldness.
Women generally see thinning of their hair by age 40.
In temporary alopecia, the hair starts growing again soon after the underlying
cause has been removed.
In alopecia areata, bald spots may occur on the scalp, along the eyebrows and
in the beard. In most cases, the hair grows back, although it may be very fine
and possibly white before normal colouration and thickness return.
When to see a doctor
- If hair loss is sudden, rather than gradual
- If a spot or patch of baldness has appeared
- If a rash or scaly skin occurs along with the hair
loss
- If you think the hair loss may be caused by medication
How is a diagnosis made?
If the hair loss does not seem to be typical balding, or if symptoms such as a
rash appear at the same time, the health professional will try to determine the
underlying cause through examination and appropriate testing.
How is it treated?
Medication
Minoxidil is a drug used to stimulate moderate regrowth of hair in patients
with male- or female-pattern balding. Younger people with small bald patches or who are only
starting to lose hair show better results, with 50% of them reporting thicker
hair or slower hair loss. However, the medication is not effective in men who
already have extensive male pattern baldness.
The medication must be applied to balding spots twice a day. Hair loss recurs
if the medication is stopped. Side effects are minimal, but some users get skin
irritation.
For male pattern baldness, longterm finasteride (Propecia, 1mg daily) can be
prescribed. There are few side-effects.
Although some risk is involved, hormone therapy may be prescribed for certain
types of hair loss:
- To speed the natural recovery from alopecia areata,
some doctors try corticosteroids applied topically or injected into the scalp.
The treatment is painful and may cause permanent scarring on the scalp if skin
atrophy sets in.
- Another steroid, prednisone, is effective for the
treatment of alopecia areata, but side effects such as weight gain, metabolic
abnormalities, acne and menstrual problems have been reported.
- In young women, hormone therapy in the form of birth-control pills may correct
the hormonal imbalances that cause baldness, thus reversing the condition.
Home
Temporary hair loss requires no treatment, except for waiting and/or correcting
the underlying cause. Treatment for permanent alopecia should be approached
with caution, as many so-called cures have been proved to be unfounded. For
most men and women with alopecia, little can be done to reverse the process.
You should take care in the sun, as baldness increases the risk of sunburn
and skin cancer on the scalp. Wear a hat or use a sunscreen with a sun protection
factor (SPF) of 15 or more. Bumps on the head can be painful because you have
less hair to cushion the blow.
Surgery
Surgery involves:
- Hair transplants, in which plugs of skin containing
active hair follicles are relocated to bald areas. A patient may need several
hundred plugs, implanted 10 to 60 at a time. Although the transplanted hair
may fall out, new hair usually starts growing from the transplanted follicles
within several months. This procedure is expensive and uncomfortable.
- Scalp reduction, likewise expensive and uncomfortable, is a procedure in
which the scalp is tightened so that hair-bearing skin from the back and sides
of the head is pulled towards the crown. The rest of the bald area can then
be filled with hair transplants.
None of these procedures will retard genetic or age-related hair loss.
Other treatments
For cosmetic reasons, many people use wigs, hairpieces and hair weaving. Tattooing
is also used on eyebrows and eyelashes after hair loss.
Prevention
Natural hair loss cannot be prevented. However, you can protect your hair from
the damage and eventual thinning caused by hairdryers, hot curlers, dyes, hair
straighteners, etc. If you do not alter the natural colour and texture of your
hair, it will be healthier. Use a basic shampoo designed for your hair type and
let your hair dry naturally.
Use a moderately stiff, natural-bristle brush to brush your hair. Full strokes
from the scalp to the tips of the hair will distribute the hair’s natural oil
evenly. Wet hair is fragile, so try not to brush wet hair. Always treat hair
gently.
Reviewed by Prof H.F. Jordaan, MBChB, MMed (Derm).
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